Background 1 Kulkarni, J. , 1 Filia, K. , 1 Fitzgerald, P.B. , 1 de - PowerPoint PPT Presentation

B-COS Gender Matters: Presenting the Profile of Females with Bipolar Disorder from an Australian Observational Study Background 1 Kulkarni, J. , 1 Filia, K. , 1 Fitzgerald, P.B. , 1 de Castella, A.R . , 1 Filia, S . , 1 Biffin, F., 1 Tahtalian, S ., 2 Dodd, S., 2 Callaly, P., 2 Berk, L., 3 Kelin, K., 4 Smith, M., 3 Montgomery, W., and 2 Berk, M. 1 Alfred Psychiatry Research Centre, The Alfred and Monash University, School of Psychology, Psychiatry & Psychological Medicine, Commercial Road, Melbourne, 3004, Australia 2 Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, P.O. Box 281, Geelong, Victoria 3220 3 Eli Lilly Australia Pty Ltd, 112 Wharf Road, West Ryde NSW 2114, Australia 4 School of Applied Social and Human Sciences, University of Western Sydney, Penrith South NSW 2750, Australia

Bipolar Disorder in Australia Gender Differences � Understanding gender differences in mental illness is Reported lifetime prevalence ranges from 0.45 to 5.5% � important (Morgan et al, 2005, Goldney et al, 2005) � Females previously under represented Constitutes over 10% of the clinical population with psychotic � illness � Increased knowledge can guide clinical decisions (Morgan et al, 2005) Service utilisation costs of equal or greater value to people � with schizophrenia, despite less chronic impairment; as well as � Gender affects the course of illness, and the expression high burden of social and occupational disablement of Bipolar I Disorder and Schizoaffective Disorder in (Morgan et al, 2005) many ways, e.g Around 50% of people with bipolar disorder unemployed � � Age at onset (Morgan et al, 2005) � Severity and frequency of symptoms � Self-reported quality of life

Women and Bipolar Disorder – Women and Bipolar Disorder - Age at onset S ympt oms and course of illness � Women typically receive a diagnosis of Bipolar Disorder on Mood disturbance as a result of seasonal changes is also more � common in women; with more depressive episodes seen in average 3.2 years later than men (Viguera, et al 2000) Autumn and Winter (Faedda et al 1993, Suhail K et al, 1998) Women more frequently experience rapid cycling and more � By the age of 25, more men(71%) than women(52%) have � severe depressive episodes. Up to 88% of people who a diagnosis of bipolar disorder. After age 30, women more experience rapid cycling are women (Robb et al 1998) likely to be diagnosed with the disorder than men (Viguera et al, 2000) Women are more likely than men to be hospitalised for mania, � however this is inconsistently reported (Viguera et al 2001, Hendrick et al 2000) � Women are more likely to experience a significant delay in seeking treatment and are more likely to experience a Women experience more mixed episodes, however this too is � inconsistently reported depressive first episode than men (Arnold et al 2000, McElroy et al 1992) (Arnold 2003, Baldassano 2006)

Women and Bipolar Disorder – Aims Qualit y of Life and Funct ioning � To replicate previous findings in a current, Australian setting � Women generally rate their quality of life, overall health and well-being as worse than men. This persists despite no � To present a picture of the average female with bipolar differences between objective ratings. disorder living in a current, Australian setting (Robb et al 1998) � Women report greater pain and worse physical health. � To understand the impact of gender on the presentation and (Robb et al 1998) outcomes of bipolar disorder � May be associated with higher frequency and severity of depressive episodes experienced by women. � To highlight the need for continued awareness of these issues (Arnold 2003) that remain a problem over time and in different settings regardless of constant advances in treatments

BCOS Study Design � The Bipolar Comprehensive Outcome Study (BCOS) is a two year, prospective, observational study of 239 participants with a diagnosis of Bipolar I Disorder or Method Schizoaffective Disorder � Inclusion Criteria: • Males or females ≥ 18 years • Diagnosis of bipolar or schizoaffective disorder [DSM-IV TR criteria, confirmed by MINI (Mini-International Neuropsychiatric Interview)] • Prescribed an approved mood stabiliser (either lithium, sodium valproate, carbamazepine or olanzapine) • Able to give written informed consent

Measures Participant Recruitment � Participants are interviewed at 3 monthly intervals and evaluated each time using the following measures: Recruited through various means including Scale Measure Rated By � • acute psychiatric hospital wards, 21 item Hamilton Depressive symptoms in past week Interviewer Depression Scale • community mental health clinics, • and through local newspapers and community group Young Mania Rating Scale Mania symptoms in past week Interviewer newsletters. Clinical Global Impressions Current symptomatology Interviewer Scale – CGI BP From two sites in Victoria � � Alfred Psychiatry Research Centre, The Alfred The current Major Depressive and Manic symptoms in the past Interviewer Depression/Manic Episode 3 months � Barwon Health Checklist The Diagnostic Interview Level of Functional Impairment Interviewer Recruitment was completed in November 2005 and last � for Psychosis (DIP) participant seen in November 2007 EuroQol (EQ-5D) Health-related Quality of Life Self-report All participants received treatment as usual and participated SLICE/LIFE Quality of Life Self-report � voluntarily 36-item Short Form Health Functional health, well-being, physical and Self-report Survey mental health

Participant Data � Data cleaning and analysis continues; full dataset at all timepoints not yet available Results � The data presented here is baseline data � Due to differences in disorders and genders, this presentation will focus primarily on females with bipolar disorder ( n =107) � Some gender comparisons will be made (total n =175)

Participants Initial Affective Episode – Bipolar Disorder Bipolar I Schizoaffective Disorder Disorder Females = 107 Females = 32 n 80 Males = 68 Males = 32 70 % of total sample 44.8% female 13.4% female Females 60 Males Nationality Female = 97.2% Female = 96.9% Caucasian 50 Caucasian Percentage Males = 95.6% Males = 100% 40 Caucasian Caucasian 30 Age Females = 42.7 Females = 40.4 Males =42.5 Males = 38.8 20 Mean age at onset Females = 22.7 Females = 22.2 (n=23) 10 (n=93) Males = 20.5 (n=26) 0 Males = 24.9 Depression Mania (n=61) Initial Affective Episode (p= .005)

Income and Employment – Females with Bipolar Quality of Life – Relationship with Disorder (n=107) partner and children Full-time job (11.2%) Part-time employment (37.4%) 56 53 Females Females Housework (21.5%) 54 52 Males Males No job at present (19.6%) 52 51 Percentage Percentage 50 Retired (5.6%) 50 48 Studying (4.7%) 49 46 48 � vs. Australian Population Unemployment Rate: 5.1%* 44 � *Australian Bureau of Statistics, (June 2005) *Australian Bureau of Statistics, (June 2005) 47 42 46 Good Poor Good Poor $1000-$1499/Week (2.8%) Relationship quality Relationship quality $200-$499/Week (66.4%) with partner ( p =.583) with children ( p =.495) $500-$999/Week (25.2%) Negative/ Nil Income (3.7%) � General population - average weekly earnings (all employees): $781.70 (ABS, Feb 2005 data) � Source: Australian Bureau of Statistics. (2005). Year Book Australia – Income and Welfare. http://www.abs.gov.au/Ausstats/abs@.nsf/0/9895157A356ED97BCA256F7200832FEA?Open, viewed 11 JULY 2005. (time of data collection)

Illness Severity over previous 3 months Illness severity at baseline 70 70 Females Females 60 60 Males Males 50 50 Percentage Percentage 40 40 30 30 90 45 Females Females 20 20 80 40 Males Males Percentage 10 70 35 10 Percentage 0 60 30 0 Normal – Mildly Ill Moderately – severely Ill Normal – Mildly Ill Moderately-severely Ill 50 25 40 20 Depression –CGI scores ( p =.043) Mania –CGI scores ( p =.254) 15 30 35 Females 20 10 30 5 Males 10 25 0 0 Percentage Normal Mild Moderate Severe Very Severe Normal Mild Moderate Severe Very severe 20 Not ill Not ill 15 Mania severity – YMRS Depression severity – HAMD 10 ( p =.274) ( p =.031) 5 0 Normal Mildly Markedly Not ill Minimally Moderately Severely Ill Ill Ill Ill Ill Bipolar –CGI scores ( p =.093)

Treatment Adherence and Hospitalisation Physical and Mental Health 50 45 Females 40 Percentage 35 Males 60 30 49.4 ± Females 9.5 25 45.64 ± 50 11.2 20 39.23 ± Males 13.3 15 35.54 ± 40 12.7 10 5 30 0 Never missed Missed a couple Missed Took less Stopped taking several than half medication 20 Self-reported compliance (p=.003) 10 � 27 females were hospitalised in the 3 months prior to baseline assessment. Two person had been admitted twice. The average length 0 of stay for females was 22.4 ± 14.6 days . Physical Component Score Mental Component Score ( p =.025) ( p = .07) � 29 males were hospitalised, and one person admitted three times. The average length of stay was 21.0 ± 12.8 days.